Implants and COVID-19: What is the role of the oral immune system in corona virus infection?

The importance of the oral immune system for the course of COVID-19 disease is playing an increasingly important role. "Prevention strengthens the immune competence at the point of origin of the viral infection and helps to avoid it or mitigate its course through this fitness function," states the President of the German Society of Dentistry, Oral and Maxillofacial Medicine (DGZMK), Prof. Dr. Roland Frankenberger (University of Marburg). (1)

"A healthy oral cavity is always a better immune barrier than a diseased oral cavity"

Prof. Frankenberger said in a statement in April. (2) The reason: the oral cavity is the most important entry point for the SARS-CoV-2 coronavirus, as most of the receptors that the virus needs to enter the body are located in the mouth. The virus multiplies in the body cells and eventually reaches the lungs. A healthy oral immune system is therefore a first hurdle for the viruses. (3)

Frankenberger cites periodontitis, a widespread disease in Germany, as a striking example. "A patient suffering from periodontitis has subgingival gum inflammation. This means that they have an open wound in their mouth, which often goes unnoticed. It is quite clear that this opens the door to a disease such as COVID-19," states the President of the scientific umbrella organization of dentistry (DGZMK). (1)

Dental implants are a sensitive area of the oral immune defense

The implant is a titanium or ceramic screw that is inserted directly into the jawbone. To ensure that it grows in well, the surface is designed in such a way that bone cells can settle well. However, where bone cells adhere well, bacteria are not far away. In particular, bacteria often colonize the transition from the screw to the bone and between the connecting piece on which the crown sits (the so-called abutment), which cannot be removed by simple cleaning.

In many cases, this leads to inflammation of the implant - peri-implantitis. This inflammation of the tissue around the implant progresses quickly, often goes unnoticed, is difficult to treat and leads to bone loss. According to studies, as many as one in five implants (20-22%) are affected. (4)

These figures show that thorough oral hygiene and regular visits to the dentist are extremely important even in normal times - during the corona pandemic, a healthy oral immune system is particularly important.

Danger recognized, danger averted - recognizing tissue degradation at an early stage

The problem with examining for periodontitis and peri-implantitis using the usual standard methods is that the disease is discovered (too) late.

When taking the Periodontal Screening Index (PSI), the dentist uses a probe to determine the pocket depth and check whether spontaneous bleeding occurs. The problem with this is that the probe can transfer harmful bacteria from one pocket to the next or even "prick" into deeper layers of tissue. If pockets are measurable, this means that significant tissue degradation has already taken place, which is usually irreversible.

The second standard method is x-rays. If bone resorption is visible on the x-ray, the inflammation has already penetrated deep into the tissue to the jawbone and has led to resorption there. This often results in the loss of the implant.

Both standard methods document existing damage and start far too late. It is much more important to diagnose an inflammatory reaction before late effects such as pockets or bone loss even occur. If detected in time, these late effects and the loss of the implant can be effectively prevented by oral hygiene measures.

Real early detection of inflammatory processes and activation of the oral immune system is made possible by immunological tests - above all the so-called aMMP-8 test.

aMMP-8: Rapid test shows the fitness of the oral immune system and implants

A simple saliva test takes just five minutes to determine how healthy the oral immune system is.

The so-called aMMP-8 test measures whether collagen degradation is taking place in the mouth as a whole or directly in the health of each individual implant. If collagen tissue is broken down, the oral mucosa is permeable to viruses and other pathogens - and therefore also to SARS-CoV-2 viruses.

This immunodiagnostic detection is far superior to an X-ray examination or a probe test. This is because the production of the enzyme aMMP-8 (activated matrix metalloproteinase-8) is caused by an activated immune system - long before damage is detected by probe or X-ray.

Researchers at the University of Helsinki and German biotech experts have developed this simple saliva test and have proven in over 400 studies worldwide that it reliably determines the state of the oral immune system.

In many practices, this mouthwash test is available as an individual health service for self-payers and costs around 50€. In addition to the professional version, there is also a quick test for home use. Similar in simplicity to a pregnancy test, this test provides information on whether the immune system is activated or not.

If the oral immune system is activated and tissue degradation occurs as a result, suitable measures must be taken to maintain the barrier function of the oral mucosa and prevent implant loss.

Individual prevention - everyone is in demand

Since an infection with coronavirus cannot be ruled out despite the best hygiene measures, everyone should strengthen their oral immune fitness individually.

The first step is to know the oral immune defense, which can be determined using the aMMP-8 mouth rinse test. If the values are elevated, this is an indication of colonization of the oral cavity with harmful germs, collagen degradation and inflammatory processes.

Professional dental hygiene reduces the number of harmful bacteria and gets to the root cause of inflammation. But you can also do a lot yourself to support your oral immune system. These include brushing properly for two minutes twice a day, cleaning with interdental brushes and using antibacterial toothpastes and mouthwashes.

The measures for a healthy oral immune system:

Other individual preventive measures include

  • aMMP8 Measurement of the oral immune system (twice a year)
  • Brush your teeth regularly (two to three times a day)
  • Daily cleaning of the interdental spaces (interdental brushes, dental floss)
  • Regular use of suitable antimicrobial mouth rinses
  • Varied, fresh and vitamin-rich diet
  • Intake of vitamin C and vitamin D



  1. Dentistry strengthens oral cavity immunocompetence and can prevent serious Covid-19 outbreaks; DGZMK press release; May 2020!/zahnmedizin-staerkt-immunkompetenz-der-mundhoehle-und-kann-schlimme-covid-19-verlaeufe-verhindern
  2. Präsident Professor Frankenberger zur Coronakrise!/praesident-professor-frankenberger-zur-coronakrise
  3. High expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral mucosa. Xu, Hao & Zhong, Liang & Deng, Jiaxin & Peng, Jiakuan & Hongxia, Dan & Zeng, Xin & Li, Taiwen & Chen, Qianming. (2020). International Journal of Oral Science. 12
  4. Pjetursson BE,Thoma D, Jung R. Zwahlen M, Zembic A. A systematic review of the survival and complication rates of implant-supported fixed dental prostheses (FDPs) after a mean observation period of at least 5 years Clin. Oral Implants Res. 23 (Suppl. 6), 2012, 22–38 doi: 10.1111/j.1600-0501.2012.02546.